Having a fistula thrombectomy
Fistula thrombectomy
A fistula thrombectomy is a procedure to remove a blood clot (thrombus) from inside a fistula.
A fistula is when an artery and vein are joined together to make a blood vessel larger and stronger. This makes it easier for us to transfer your blood into a machine and back again if you have dialysis.
Preparing for the procedure
There are some things that can help you to prepare for the procedure.
Do
- Contact the interventional radiology (IR) department in advance if you need a hoist (piece of medical equipment to help lift or move you safely), transport or a translator.
- Arrange for an adult to take you home by car or taxi, and to stay with you overnight.
- Tell us if you take any medicines regularly. This includes medicines that you buy yourself from a pharmacy or shop and any herbal or homeopathic medicines.
- Bring an up-to-date list of all your medicines with you. This includes the names and amounts (doses) of any tablets, capsules, inhalers, sprays, liquids or patches that you take.
- Tell us if you are allergic to any medicines.
- Tell us if you have any other medical problems.
- Tell your doctor or nurse if you have diabetes. You may need to change the amount (dose) of your diabetes medicines because you stop eating and drinking (fast) before the procedure.
- If you take any medicines containing metformin, stop them on the day of the procedure and for 2 days afterwards. Metformin is a medicine used to treat type 2 diabetes and diabetes in pregnancy (gestational diabetes).
- Tell your doctor or nurse if you take any anticoagulants (like warfarin or rivaroxaban) or antiplatelets (like aspirin or clopidogrel). These are medicines that help to prevent blood clots. You might need to stop taking them temporarily before the procedure. The doctor referring you should give you specific instructions about this. If they have not, you can contact us for advice when you get your appointment letter.
- Take your regular medicines (with sips of water if needed), unless your doctor has told you not to do this.
- Drink water (but not fizzy water) until 2 hours before the procedure.
Don't
-
Do not eat or drink anything (except water) for 6 hours before the procedure.
At your pre-assessment appointment, we give you more information about when you need to stop eating and drinking (fasting instructions).
You often have a general anaesthetic (a medicine to make you sleep during the procedure) because you need to lie still. If we give you an anaesthetic or a sedative, fasting reduces the risk of your stomach contents entering the lungs during or after the procedure.
We also give you more information on stopping any medicines when you come for your pre-assessment.
Giving your permission (consent)
We want to involve you in decisions about your care and treatment. If you decide to have a fistula thrombectomy, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.
You can read more about our consent process.
On the day of the procedure
Unless you are already staying in hospital, you need to come to the renal day unit (Patience ward) at Guy's Hospital. Please arrive 15 minutes before your appointment to allow time to prepare.
You can ask the IR doctor any questions that you have. We then ask you to sign the consent form confirming that you agree to have the procedure.
You have the procedure and can then usually go home on the same day after a period of being monitored.
During the procedure
We bring you to the interventional radiology (IR) department. The IR doctor and nurse check that you have followed all the guidance to prepare for the procedure.
Usually, the procedure takes 2 to 3 hours.
What happens during the procedure
- We ask you to lie on your back.
- We put a thin tube called a cannula into a vein in your arm. This allows the IR doctor to give you any medicines during the procedure.
- We take you to the operating theatre. You have a general anaesthetic (medicine to make you sleep during the procedure) or sedative (medicine to make you sleepy).
- We support the arm with your fistula on an arm board. The IR doctor may make the skin numb by injecting a local anaesthetic medicine. They may do this before or at the end of the procedure.
- Using special imaging equipment for guidance, the IR doctor clears the blood clot.
- The IR doctor puts a small plastic tube called a sheath into your arm with the fistula. They treat the narrowings in the fistula by inflating a balloon within them.
- Sometimes, the IR doctor may put in a tiny metal tube called a stent to keep the narrowings open.
- At the end of the procedure, we put a single stitch at the place where we inserted the sheath (the puncture site). We also put on a sterile dressing.
How the procedure feels
The team looking after you make sure that you are as comfortable as possible during the procedure.
If you are uncomfortable, the doctor or anaesthetic specialist (anaesthetist) may give you a strong painkiller or sedative.
Resource number: 4650/VER2
Last reviewed: March 2024
Next review due: March 2027
A list of sources is available on request.
